Linguistic isolation correlates with length of stay and mortality for pediatric oncology patients in California

Abstract

Objective: To evaluate social drivers of health and how they impact pediatric oncology patients' clinical outcomes during pediatric intensive care unit (PICU) admission via correlation with patient ZIP codes. Methods: Demographic, clinical, and outcome variables from Virtual Pediatric Systems®, LLC for oncology patients (2009–2021) in California PICUs (excluding postoperative) using 3-digit ZIP Codes with social drivers of health variables linguistic isolation, poverty, race/ethnicity, and education abstracted from American Community Survey data for 3-digit ZIP Codes using the Environmental Protection Agency's EJScreen tool. Outcomes of length of stay (LOS), mortality, acuity scores, were compared with social variables. Results: Positive correlation between mortality and minority racial groups (Hispanic/Latino) across ZIP Codes (correlation coefficients of 0.45 (95% CI: 0.22–0.64, p < 0.001) in 2017, 0.50 (95% CI: 0.27–0.68, p < 0.001) in 2018, 0.33 (95% CI: 0.07–0.54, p = 0.013) in 2020, and 0.32 (95% CI: 0.06–0.53, p = 0.018) in 2021). Median PICU length of stay significantly correlated with linguistic isolation (coefficient of 0.42 (95% CI: 0.18–0.61, p = 0.001) in 2021 versus −0.41 (95% CI: −0.61 to −0.16, p = 0.002) in 2019), which included PRISMIII (n = 7417). Mixed effects logistic regression model for other constant variables (PRISMIII, cancer type, race/ethnicity, year), random effect of patient, linguistic isolation (percentage as a continuous value) was significantly associated (95% CI: 1.01–1.06; p = 0.02) with mortality; (OR = 1.03). Conclusions: Linguistic isolation was correlated with LOS and mortality, however variable year to year.